Manifestations of Gastrointestinal Disease in the Child

More documents

Recommendations

Info

Gastrointestinal Disease in the Child 709 FIGURE 3. Type III failure to thrive. W refers to weight, H to height or length, HC to head circumference. 3. Detection of any chronic disease which may be contributing to impaired growth 4. Assessment for signs of possible child abuse 5. Developmental assessment Observing the interaction between parent and child during a feeding session may provide valuable insight into their relationship. This session should occur when the child is hungry and particular attention should be paid to the child’s ability to cue to the parent, the warmth of the interaction, and the parent’s ability to read the child’s cues of hunger and satiety. 4.6 Investigations The large majority of infants will require no immediate investigations unless the history and physical examination have suggested the likelihood of a medical cause such as malabsorption. If children do not respond to adequate calories for nutritional rehabilitation then possible malabsorption should be investigated. Tests might include stool for fat and reducing substances, a sweat test for cystic fibrosis and possibly a celiac antibody profile.
710 FIRST PRINCIPLES OF GASTROENTEROLOGY 4.7 Management Management begins with identifying the underlying factors contributing to undernutrition and correcting them if possible. In more complex cases it is very helpful to have a multidisciplinary approach with physician and nurses, dietitian, social worker and, if indicated, a behavioral psychologist or feeding specialist. The goal of nutritional management is to promote compensatory catch-up growth. Children diagnosed with growth failure secondary to protein calorie malnutrition may need to receive up to 150% of the recommended daily caloric intake for their expected, (not actual) weight for age. This is usually achieved by attempting to provide nutrient-dense food. For infants, the caloric density of formula can be increased and, in toddlers, nutrient density is increased by enriching preferred food with butter, peanut butter, oil, cheese or carbohydrate additives. Fruit juice may contribute to poor growth and should be limited to 240-480 mL/day. Small, frequent feedings should be offered. In cases of moderate and severe malnutrition, a multivitamin supplement should be offered. Severe malnutrition should be managed in-hospital, with close monitoring of electrolytes and fluid balance to prevent refeeding syndrome. 5. ACUTE DIARRHEA IN CHILDREN / J.D. Butzner 5.1 Introduction A North American child will develop between 6 and 12 episodes of acute diarrhea before the age of 5. This contributes to approximately 12% of childhood hospitalizations and approximately 300 deaths per year. Worldwide, acute diarrheal disease is the leading cause of childhood morbidity and mortality, accounting for three million deaths each year. Most deaths are caused by failure to treat acute dehydration properly and to correct electrolyte imbalances. Studies from both the developing and developed world demonstrate that hospitalization can be avoided and morbidity and mortality can be drastically reduced by the prompt introduction of two simple treatments: oral rehydration therapy and early refeeding. In spite of recommendations to use oral rehydration therapy and to continue or resume feeding early in mild to moderate diarrheal illnesses, the use of unsuitable treatments persists. These include unnecessary intravenous therapy, inappropriate oral fluids (unbalanced sugar-electrolyte solutions), prolonged starvation with a slow introduction of limited feeds, and the inappropriate use of antibiotics as well as antimotility and antidiarrheal agents. 5.2 Pathophysiology of Acute Diarrheal Disease An understanding of the physiology of intestinal fluid, electrolyte and nutrient transport provides a basis for understanding the mechanisms of acute diarrheal disease and successful oral rehydration therapy. Water absorption occurs
Page 2 and 3: 14 Manifestations of Gastrointestin
Page 4 and 5: Gastrointestinal Disease in the Chi
Page 6 and 7: lying organic disease, continued no
Page 12 and 13: 2.1.6 MANAGEMENT Management of the
Page 16 and 17: apnea, or are very intermittent, as
Page 56 and 57: decreased bile excretion leads to i
Page 58: Gastrointestinal Disease in the Chi

Manifestations of Gastrointestinal Disease in the Child

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?